Farewell to Starhill ....... But its not the End

It has been a gruesome month where if some of you may have noticed, our clinic has been pretty much inactive. I have to apologise to all my patients and blog readers for the hiccup. The reason for the long silence was because we were busy moving. Yes, finally Faceworks has left Starhill.

For the initial part, I thought of taking a break from seeing patients and running a clinic. Faceworks has been my blood, sweat and tears since 2008. Being a lonely captain, it can be tough sometimes especially since the rentals were exorbitant, and the economy was flip flopping year to year. Not to mention the non-stop ongoing renovations that just seems endless.

However, despite the odds, I do have many patients and followers who have supported me all this while. So my initial thought of rest, was cut short. I have an obligation to my patients. So after the move, I started negotiating venues in order to continue my service of care for my loyal patients, to allow them the benefits that they have had before. After a few discussions, finally I've decided to join up with a senior of mine in Gleneagles Medical Office block, i.e. the private clinics.

For this month, the intended suite is still under renovations, so for appointments, I'd have to use his current suite, hence the appointment only basis is a complete must. I've retained one of my nurses Mia to help keep track of all the appointments and assist during procedures. There is so many small things to do and complete like switching phone lines etc, which would take awhile. But do not fret, our clinic mobile and gmail is still functioning - Email us and we will respond as soon as possible.

The coolest thing about moving is I get to breathe better and I get to play with Thermage. Oh yes, my senior has a Thermage that have tips expiring in this year and he has given me the permission to use and promote so that the consumables do not go to waste. So for the past week I have been doing a few Thermage cases, that actually gave not just the patient satisfaction but even my team, especially when my extended protocols for neck, and breasts are applied. I will write a full entry on Thermage in the next couple of days so that you understand what the hype is all about. If you are to curious, you can check out their official page here http://www.thermage.com/ .

So basically, all our usual services are available except for some machines since I need to arrange for them to be moved over. We are thinking to fix up my Starlux, so then I can expand my services to more interesting things. We'll see how it goes. We'll be having a mother's day event to invite patients over to introduce the new place and new services. Do email or text us if you are interested to attend. I also realised that some people are having problems accessing our website. Our website is currently on www.fwclinic.com  in view of a miscommunication with our previous web hoster. Even our store has moved to a different URL but the function is still the same http://fwclinic.com/store/.

I would like to thank all my patients, friends and followers who have been with me and supported us all this way. Without patients, I am no longer a doctor - without the patience and the care, I wouldn't be where I am now. Faceworks in Starhill is much loved, and we had so much fun there with events, parties, memories. It is sad to leave but in order to succeed we need to move on. So worry not, Faceworks may no longer be in Starhill, but we are still available, still functioning to provide to you the best aesthetic treatments with that pampering touch. Hope to see you soon.

For more information or appointments please email us at faceworksclinic@gmail.com or call us at 014-2233268.

Célebre - Aphrodite's secret potion leaked out....

Finally, I have some quiet time to sit and write my blog. I have this issue of requiring a wide open space to write, ideally with trees, a breeze and natural sunlight. Mornings are the best, after my little minions are sent off to school. Being unwell since Chinese New Year which makes it close to a month now, a lot of my activities have been limited. Although some people may feel that its bad, I actually find peace in my inability to speak much and keeping silent. A silent mind brings forth fresh ideas, and it helps rationale things better. Oh yeah, I am actually enjoying the voice rest, I have a good excuse not to call people or pick up the phone.

Anyway, let's talk about Célebre. Célebre is the name of a Company in Geneva that specialises solely in Cell Therapy and advanced anti-aging specialties. Its team comprises of their own medical doctors, stem cell therapy consultants, researchers, chemists, biotechies and developers to create their own line of 'stem cell' products. The team has been around for quite awhile but this line of product was only introduced in 2012.

So why are the Europeans so hyped up about cell therapy and stem cells? The idea of stem cells as a form of alternative healing for humans began as early as 1931 where Dr Paul Niehans, a swiss doctor amazed the conventional world by saving a woman with her parathyroid glands accidentally removed during thyroid surgery. He took parathyroid glands from a sheep, crushed them, diluted with saline and reinjected the concoction into the surgical area. The woman survived, without much complications. He was also said to have treated a lot of celebrities with an amazing stunt of allowing an 80 year old an to impregnate his wife for their last child. In 1954, he was called to the aid of Pope Pious XII who was dying. The poor Pope was in critical state with only glucose infusion as he cannot tolerate any food or water. For 2 months, he nursed the Pope and within a few weeks he was able to tolerate orally and his power regained. Hence why the Anti-Aging Medicine world dubbs Dr Paul Niehans as the Father of Stem Cells. Even in the older days he managed to heal and prolong life, makes you wonder what more can he do with today's technology? Regardless, such extreme treatments received a lot of criticism from the medical world and professionals especially with the cost of treatments which are somewhat excessive.

                                

     I am a believer of stem cell therapies, but I am very skeptic as many parties try to take an idea, try to duplicate at a lesser cost (hence reduces quality, efficacy, dosing etc) and then mass promote with an extreme marketing gimmick. So hence my approach to Celebré was also very skeptic. So what better way to find out rather than try it myself. (And no, the Company did not sponsor the placenta supplements). What I am bound to write are the effects based on my own experience consuming this supplement, it may differ from individual to individual.

So I decided to test out the oral sheep placenta capsules. I have been trying a few brands over the years, but I guess this one did catch me by surprise. It comes in a standard box of 30 soft capsules. It is quite big, but swallowable. The good thing is the absence of any after taste that you get with some other supplements. It has a slight scent, but not smelly. I take one every morning on an empty stomach. I always take my supplements ideally on an empty stomach, because only then the best absorption occurs. For something this expensive, I'd want it to absorb as much.

The first week, I did not feel much difference. I was a little bit sleepier the first couple of days, but subsequently resolved. My energy level remained the same, and so was my appetite. But after consuming more than 7 days, I started noticing my skin texture feels softer, by the end of the second week, it felt as soft as my little girl. Even my staff noticed. My skin appeared to glow. It was cool. After the first box, I did notice some of my pigmentation appeared lightened. The skin remained soft. I guess this placenta focuses more on skin health rather than anything else. 

After the first box, my skin looked so healthy that people started to ask me what have I been doing. I didn't even need to apply much lotion, my skin kept hydrated.

The most question I get when I tell them I am on placenta supplements is about menses cycle and break outs. I have to admit, the first month I had more breakouts than usual and more menses pains compared to usual. But towards the second month, the breakouts lessen, and I was without much menses pain. I guess, it does affect your hormones as well. Another question people do ask me is about how hot do I feel taking the supplement? Compared to other supplements, I would say it is tolerable. I think I sweat a bit more, and probably feels warmer to touch compared to when I am off it, but its not as bad as consuming deer placenta (super heaty).

So I've taken myself of the capsules for a bit, just to observe the effects. My skin remained super soft and hydrated for a good 2 weeks after stopping, and even now, although I feel that it can be softer, I feel that it was much better than before. According to their protocol, they advise to take 3 months directly then subsequently maintain by consuming two to three times a week. A box of celebré costs RM 880 for a months supply of 30 tablets. I'm waiting to restart on my 3rd box and then maintain.

This brand also comes in IM forms of placenta extracts, fetal extracts, fresh frozen cells, and they even have a Vegetal extract. However, as you guessed the products are in their thousands, and it is a science which many still argue about till today. Still, I have seen some people on the direct innoculation forms, and have seen how much it has kept them un-aged. Personally, I would subject myself to these alternative treatments once I start to feel my changed healthy lifestyle unable to ward off the signs of aging.

For the record, I do not smoke. I sleep early. I do not consume any form of alcohol and I am on a low to no sugar diet daily. I also exercise daily and do not take preserved foods, MSG and other chemically infested food products. I wear sunblock religiously and I drink at least 3 litres of water daily. So, your results may vary with what I have experienced. Lifestyle plays a very important role for skin health. The supplements will help, but for the best results, you will be required to do a few life style modifications. It is not just for placenta but other supplements as well like vitamin C, glutathione etc etc.

For more info or to order do contact us at faceworksclinic@gmail.com or call us at +6014-2233268.

Easy Dew - Simple solution for Asian skin....

                             

Happy Chinese New Year Peeps..... It seems like the New Years are pretty much closer together this year with a mere 1 month apart of each other. In Malaysia, Chinese New Year is celebrated with massive decorations, fireworks, reunion dinners, loh sangs and dragon dances. This year is the year of the horse and everyone is feeling the spirit of the wooden horse energising efforts of productivity for the year.

So to start of this year,  I would like to introduce a new medical cosmetic product from Korea. It's called Easy Dew.

Well, what is so special about this range of products? The Koreans are known for their enthusiastic approach towards medical aesthetics and the in depth research and development of products and techniques. EGF is not a new player in the world of aesthetics. Initially the technology was used mainly in scar treatment to aid treatment and reduction. The development of Easydew followed from a request of a patient receiving diabetic foot treatment from a sister product called Easyef dermal solution. Seeing as how the product was able to help with her healing diabetic wound, she wondered how it would affect her face. Dr Jun-Pyo Hong, M.D. , a plastic surgeon of ASAN Medical Center decided to take up the challenge and presented a cosmetic R&D proposal to Daewoong Pharmaceuticals. Together, they developed a medical cosmeceutical that helps to prevent post treatment unwanted side effects while maximizing treatment efficacy starting from the cells using the skin restoration mechanism of the protein EGF that exists in the system. Although initially the skincare range was designed for post procedures, we do find that it works for most normal to dry skin with very marked improvements.

This product came out in Korea in the year 2012 and has made quite an impression in the medical cosmetic world. Using the latest technology of DW-EGF, allows the creation of a stable safe skincare that gives wonderful results. 

So what are the effects of DW-EGF to our skin? Here's a simple diagram to demonstrate:

Here is a control study on the skincare that show's the improvements within weeks. 

Well, we did our own study with the product. We had 5 subjects who volunteered their faces. Each subject was given a treatment ranging from PRP to peeling to Dermaqueen facials and was given a sample of the products with instructions to use on only on the left side 2x daily. The study was suppose to go on for 4 weeks but after the 2nd week, we decided to stop because all of the participants experienced the left side being lifted more than the right side, thus was looking more obvious as the day went. Overall all 5 participants found that the product was easy to apply. The texture suited more of the Normal to Dry skin. All of the participants noticed an improvement as early as the first week, and the improvements seen were the skin textures, pores, lightening of pigments and lifting effects. Even after stopping the products after only 2 weeks of usage, the tightening effect lasted for another good 2-3 weeks after. 

I took a set to try out. The cleanser was pretty good. A small amount was required to clean the whole face and it strips of all the oil from your face. The active soothing serum is perhaps one of my favourites. The light texture serum absorbs almost immediately into the skin leaving it soft and smooth. I had an Obagi peel done on my face prior to using this product, and I do feel that it does reduces the downtime. Usually my face will peel for 5-7 days on Obagi Blue Peel Radiance, but this time round, I had minimal peeling or redness for 3-5 days. However, the most highest concentration of EGF is found in the Easydew EGF Repair Control which is also the most expensive product for the range. It comes in a long fancy bottle. You only need a little bit of cream to apply to your whole face. I loved the texture and how it absorbs almost instantly without a sticky feel. After these 2 steps, you may want to maintain with a good moisturiser. This range comes with 2 types of moisturiser - The Easydew Renewal Intense Moisturiser or the Easydew Renewal Moisturiser. The Intense moisturiser is designed for more elderly or dry skin and is a tad too rich for people below 45. However, if you have very dry skin, this is perhaps a good solution for you. It comes in a 50ml packaging but you will just need a small amount to apply on your face and neck. The Renewal moisturiser is a less thick cream which is more suitable for younger or oily skin. I've also tried out the sunblock which is an SPF 40 with both UVA and UVB coverage. My verdict, its a good sunblock but I think it made me look a bit white. Although it may feel sticky in the beginning, but it absorbs within minutes and the stickiness disappears. It also has some EGF in it that helps to lighten pigmentation.

So now we come to the most important bit, the price. To be honest, it is not exactly cheap. But for the results it can show within 2 weeks I would say its worth every penny. Especially when too many cosmetic products promise so much but delivers so little. The price for each product is between RM 88 - RM 160 with the Easydew EGF Repair Control priced at RM 268 per bottle. If we were to compare to the other cosmetic counter products like Lancome, La Mer or SK II, the price is acceptable. The best part is, there is also a trial kit you can purchase to try out this product before making a decision. 

This trial set consists of 6 items is only RM 248/= and consists of a toner, Active Soothing Serum, Repair Control EGF, Renewal Moisture, Sunblock and BB Cream. These products are available in the clinic with preorder, so if you are interested to purchase or try out, please feel free to contact as at 03-21440080 / 0142233268 or email your enquiry to faceworksclinic@gmail.com. You can also Like us on Facebook ( https://www.facebook.com/FaceworksClinic ) and send your enquiries there. 

Happy New Year... 2014

Its the start of a new year. Time flies ever so fast. Reminiscing back to the earlier days of running the clinic, how much things have changed. Now, my skills are more than grown, I have started to train other doctors for most of the filler and botulinum toxin techniques. I have a good team, with a strong manager to help manage most of the clinic day to day dealings. We've established the appointment only concept that not only allows you to plan for your appointment, but for us to make the best of your time. My foreign patients love this concept, the locals are still trying to get use to it.

We've made a lot of new allies for this year, and new projects are unveiling. We may have dropped a few, but the aim is to move forward, hence we need to focus on the positives. We have good and loyal patients, we have a lot of new ones too. With the new regulations hopefully Malaysia will be able to compete with its neighbouring countries in terms of Medical Aesthetics more proactively and provide overall great service and good reputation.

Unfortunately, there are still a lot of people who fall prey to beauticians doing injections etc, providing so called professional exclusive services. An overall price comparison, their prices compared to doctor prices are pretty much similar with perhaps a few hundred difference. I have been consulting patients whom have had beautician work done on their face and overall most of them are not happy with the work, but the worst part is you can't remove it, unless of course surgically. And most surgeons would charge a bomb for having to clean up someone else's mess, plus the complications that may arise from the surgery.

So for the start of this new year, I would like to give a take home message to all my readers who may consider improving their looks for this year.

5 Reasons Why You Shouldn't Let Anyone Else But A Trained Dr Poke A Needle to Your Face

1. The Face is the first thing a person notices when they look at you. Getting fillers or BTA from an untrained hand may make you look weird / disproportionate / abnormal. Every trained medical aesthetic practitioner goes through measurement training and ratio training that allows them to make an educated assessment of your face's needs and amount required. Beauticians only inject base on what they think is pretty but not based on scientific guidelines. What may be pretty to them may not be pretty to anyone else.

2. Beauticians are not taught surgical anatomy. Yes, they may argue, they have anatomy syllabus in their courses but it is very non-specific and mostly related to massage techniques. Even doctors who are not trained in medical aesthetics have issues with face anatomy (I conduct training, I know) and most only know basic. You need a really in depth knowledge of the anatomy of the structures of your face before you can safely poke a needle in it. There are many areas which you cannot inject or even if you did required high level of care. There are reported cases of skin necrosis, granulomas, etc with filler injections even with the most trained hands, what else an untrained hand? And what more a non-medical personnel who doesn't even have the basic.

3. The collagen that beauticians keep saying they are injecting are not 100% collagen. The source is questionable, most are taken from China since its super cheap there and unlikely to be sterile. For those with religious preferences, most collagen for fillers are bovine (cow) or porcine (pig) in origin. We will never use marine sources because of very high allergy rates in humans. Sometimes, they even use human collagen (which I have no idea how they extract). Another issue is that most of the time, liquid silicone is included in the concoction to give it better volume for less usage and for the effect to stay longer (rather permanent). My simplest advice would be to be inquisitive about the product you use - see the packaging, make sure the box and the filler is the same thing, make sure it is sterile, and make sure you can actually read the label on the box.

4. Any break in the skin allows bacteria and viruses to come in and cause a local infection. Doctors are drilled with need for sterility for all procedures even before they graduate. Beauticians and other non-medical injectors are not trained towards sterility. How sure are you that the needle they use has not been used before, how sure are you that their swabs are not expired? What about communicable diseases? How healthy is your injector? You have no idea about their own medical background. Furthermore, if a doctor's procedure gets infected, the doctor can treat and prescribe antibiotics, what can your beautician do besides ask you to seek help from a doctor?

5. Beauticians charge cheaper? On contrary, you may be paying so much more for what they are worth. Most beauticians will charge 5-10 fold of their cost price, whilst most doctors would charge base on the market price for a certain product and their experience. I had one patient who went to a beautician for a nose filler and was charged RM 15K. Luckily she only paid half, but with the amount of money, I told her she could have gotten a proper rhinoplasty done. She was unhappy with the filler work which made her nose look so big that she was depressed. Then she had to spend another RM 6K to remove it from a surgeon and a few more $$ for a proper rhinoplasty. Altogether, she spent almost RM 50K for something that she could have saved if she had consulted a proper doctor to begin with.

The medical aesthetic industry is a very lucrative industry which most Malaysians are starting to realise nowadays. Hence many people will try to grab the opportunity to be in this industry. Its not a bad thing, but personally I feel that you should only sell a skill that you possess and able to handle inclusive of the consultation and complications. Although the government has imposed certain regulations on Medical Aesthetics and Beauticians, however, enforcement in Malaysia is very poor. Because of this, as a consumer, it is your own responsibility to make an informed educated decision when deciding on any procedure. Remember, all medical aesthetic procedures are elective - take your time to do your own research and sleep on it before deciding. If you are not comfortable with the injector, just walk away. Its your face anyway. Hesitation is better than regret.

Happy New Year Peeps!! Look out for more interesting blog entries for this year.

For more information or to contact us directly please call the clinic at 03-21440080 / 014-2233268 or email to us at faceworksclinic@gmail.com. 

Redensity II - Solution for tear trough

      Dark under eye rings can be such a nuisance to many of us. It makes you look tired, sick or just unhealthy. But some people are genetically prone to have rings under the eyes. Being Asian, we are predisposed to have a more prominent under eye problem due to the structure bone which is flatter than others. In Indians, we would see a hollower eye socket and thus appearance of the eye ring is more prominent especially with age and we start losing some of our malar fat. Look in the mirror and you will notice that the area next to your nose tend to appear flatter, and in some people there is a line. This is what you call a tear trough line.

Over the years, doctors have been using soft fillers to treat this problem. The light weight fillers give a satisfactory effect but only lasts approximately 3-6 months and the cost is high. Much sturdier fillers may cause lumps and bumps and not to mention the Tyndall Effect. 

What is Tyndall Effect?

The Tyndall effect, also known as Tyndall scattering, is light scattering by particles in a colloid or particles in a fine suspension. It is named after the 19th century physicist John Tyndall. It is similar to Rayleigh scattering, in that the intensity of the scattered light depends on the fourth power of the frequency, so blue light is scattered much more strongly than red light. An example in everyday life is the blue colour sometimes seen in the smoke emitted by motorcycles, particularly two stroke machines where the burnt engine oil provides the particles.

In relation to the tear trough, when fillers are placed beneath the thin skin, there is a chance of this effect occurring especially if the fillers are placed too superficially. The only way to remove it is by dissolving the filler with Hyaluronidase. However, even this does not guarantee 100% reduction of the Tyndall effect. Despite the fillers lasting less than a year, I have come across people with Tyndall effects lasting up to 2 years. Thus, in this case, cosmetic concealer would be prescribed. 

Hence my reservation in treating tear troughs in the past. I usually treat the malar area wmith fillers by replacing the lost of fat pads and volume. It gives satisfaction to most patients but there are those who require a little bit more. Thankfully since last year Teosyal came up with a filler designed especially just for tear trough - Redensity II.

Redensity II is a new age filler which allows thin area injection without causing Tyndall effect. It is a hyaluronic acid filler that is combined with a restructured complex of vitamins to tackle tear troughs, dark circles and fine lines around the eyes. It exerts minimal pressure on surrounding tissue giving the eye a homogenous, long-lasting and natural fill. A clinical study done on test subjects find that 100% of candidates would recommend this procedure to be done as it is quick, with minimal downtime (some none at all) lunch time procedure that gives satisfactory results.

But no matter how good the filler, the injector must be well-trained and have steady hands to give you the best result. It is a pretty forgiving filler which allows some room for error and will recorrect itself. Done by trained hands you will have minimal to no bruising. This service starts from RM 1500 / session and the effects lasts up to 12 months. I'm completely in love with this filler and now using blunt needles, this service is comfortable and gives wonderful results. The best look is after 2 weeks but immediately after you can see the difference.

For more information or appointments do contact us at 03-21440080 / 014-2233268 or email to faceworksclinic@gmail.com. You can also LIKE us on Facebook and send your enquiry through there.

Beautiful Breasts...... How to fix my sagging breasts.....

When we think about women, breasts are one of the things that pops in mind. Despite the gender differences in aspects of discussion, it will always still be a topic. Men would normally talk about cleavage and size (one of the first thing a man notices in a woman they bump in the street), whilst women would be talking about size, sag, lag, etc.... In this modern world, looking our best is now a requirement not just an option. The way you look really plays a major role in the confidence you portray. Despite what some people may say about looks does not matter, reality is, it does. We all know that. 

Breasts are part of every women. It is a differentiating anatomy between male and female and serves as feeding organ for babies. One thing that a lot of women worry about is size. Most women prefer big breasts but it needs to be proportionate to the body. Too big breasts can lead to health problems and it estimated that too large a bust can reduce a woman's lifespan by 5 years. The main problem that most women with a huge bust will have is additional pressure to the spine which causes pain in the long run. Its either they extend their back more to compensate for the weight or slouch due to gravity hence leads to long term abnormal posture thus causes spine problems and even muscle pains. Sometimes when the size is too big, women have difficulty in breathing and are unable to sleep on their backs because the breasts add pressure to the chest. It can also cause headaches and migraine due to constant strain to the surrounding structures. Too huge breasts also can have skin implications as fungal infections occur easier due to bigger folds and bigger bra straps can cause abrasions and affect skin health. There is also a more significant risk of weight gain for women with bigger breasts as the big bust limits a lot of physical activities due to strain onto the muscles, ligaments and spine from the weight. Thus there is a reduction in exercise that leads to weight gain. Big breasts also causes stress for a lot of women, especially with their own self-confidence. A study done shows that women with excessive breast size have reduced confidence due to the breast size, especially if it becomes an object of banter or joke in their society. If you have any of these symptoms, the solution to it is breast reduction surgery which should always be done by a trained plastic surgeon.

In Asia, the more problem is small breast size and breast sag especially after breastfeeding. Luckily for us, medical technology has come a long way to helping solve these woes. For breast size, despite multiple methods promised by the media I would still say if you are really decided go for surgical breast implants by a well-trained plastic surgeon. The high-grade silicone implants would be good for at least 10 years without any other complications. Low grade implants may burst and cause massive tissue scarring and would require surgical removal. Normal saline implants are still encased in silicone and may leak and reduce in size over time. Silicone injections are banned for use in many parts of the word due to the complications that arises from it. There was a hype for fillers but the effects were only a maximum 1/2 cup increase and lasts longest 1 year in terms of aesthetic effect but may cause scarring and calcifications. Not to mention the cost than is not cheap and usually I would advise my patients for permanent implants instead. Fat grafts are also used but it depends on the skill of the doctor. You may need to top up after 3-6 months and the effect can last up to 2 years. There is still risk for tissue scarring and failed fat graft, not to mention the cost.

Now, we come to sagging breasts. Why do breast sag? 

1. Age 

The most common factor is age. As we grow older, there is more gravity pull and our ligaments start to become more lax. There is no muscles in the breast, only mainly breast tissue, fat and other connective tissues. The connective tissue is also called the "Cooper Ligaments" starts loosing its elasticity as we age.

2. Running without proper support.

Over-bouncing of the breasts can make the breasts sag faster. Hence why we are recommended to wear proper sports bra to support our breasts. When a person runs or does strenuous exercises, the breasts move everywhere in an 8-like motion. Without proper support, the breasts move too freely that can lead too over-stretching of the Cooper's ligaments leading to sagging.

3. Changes in weight and/or hormones.

Extreme diets and extreme weight loss/weight gain can lead to sagging. Pregnancy causes sagging in women and is proportionate to the number of pregnancies she has. The key here is gradual changes to the body, will not affect the breasts too drastically. Breastfeeding DOES NOT contribute to breast sagging, so give your babies all the milk that he/she needs.

4. Smoking

If you love your breasts then you should quit smoking. Smoking not only causes other harmful effects to the body, it also breaks down elastin which is a protein that gives the skin elasticity. Reduce elasticity causes sagging.

So how to improve sagging?

The definitive treatment is to do a breast lift but even this surgical procedure is not permanent due to the factors which cause sagging and after awhile the ligaments are just going to lose its elasticity and sag again. Not to mention the cost, the downtime and risk for scarring. Other methods in medical aesthetics includes use of Laser to tighten the skin around and above the breast to lift it up but this also is temporary. My favourite would be to use Gentle-YAG or any long pulse ND-YAG 1064nm at a tightening setting to give that additional lift. It can be a little bit painful during the procedure as it requires a longer interval that the normal rejuvenation protocol. Cost for each treatment varies on type of laser ranging from RM 1000-RM 2500 per session. In my clinic, we have Fraxel that can also help to a certain extent for breast tightening but it would be more of skin rejuvenation over the décolletage area avoiding the breast tissue. Some places do RF tightening for breasts, but it requires multiple sessions at close intervals and results can sustain up to 6-9 months after completing the course. However, we do not recommend RF on the breast tissue areas since it may lead to reduction in volume. This method also requires good knowledge of anatomy on the person handling the RF, but at least it is a cheaper alternative. 

Threads for breast lifting.

The Korean influence has increased the usage of threads in medical aesthetic practice. Now more doctors are promoting threads for breast lifting as an alternative to surgical breast lifting. The results are quite interesting although the is still risks of bruising and pain, and some downtime. If placed correctly, you will not be able to feel the threads. Depending on what you wish to achieve, the doctor would advise you on type of threads and how many you need. The two common ones used are suspension threads and PDO threads. Other threads would require surgical anchoring to allow the threads to stay in place. Suspension threads would give you a good lift for 18-24 months almost instantly and usually you will need 2-3 per side. Cost for the procedure is anywhere between RM6-10K at the moment. PDO threads on the other hand takes up to 3-6 weeks to start showing results as its mechanism of lift is more of collagen stimulation. You may require anything from 50-100 threads per side and probably a combination with suspensory threads. PDO threads is common in Korea, China and Japan. In Malaysia, be aware of beauticians and unregistered 'doctors' also doing this procedure since it is so easy to buy it off Alibaba.com. Price ranges anything from RM 2000-RM 6000 per session but you will need multiple sessions (3-5X)  in short intervals before the end result. The complications also includes pain, swelling, bruising and possible failure or infections if not done properly. For the record, I have not started this service but if you wish to try it out, I can direct you to my colleagues who do.

PRP for breast lift and rejuvenation.

Now this is a method that I am pretty interested about. This year, I have been studying a lot on this particular technique and had the chance to tutor under a very knowledgeable senior on this matter. Dr Rahmat has been practicing for over 20 years and at one point was teaching anatomy to students. Anatomy plays a very important role in achieving good results and avoiding complications. Using his technique which involves using PRP as a natural glue to strengthen the Cooper's ligament and keeps it perked. The growth factors concentrated in the PRP also helps to rejuvenate the ligament via encouraging new cell growth and improving collagen and elastin. The real mechanism is still uncertain. More superficial injections are also done to improve the overall breast appearance and lighten the areola to for a more rejuvenated and youthful look. I have done a couple of treatments for patients and overall were happy with the treatment. I injected myself with my own PRP to observe the changes and I noticed there was initial swelling and fullness that lasted approximately a week. There was a size change, and I had an extra 1/2 cup that lasted me at least 6 weeks before shrinking again. There was definitely a lift and my nipples points a more symmetrical fashion nowadays. There was not much areola lightening since I didn't inject much at the areola (Its painful when you are doing it on yourself). I did one on my manager and she had a better lift and 1/4 size improvement and results lasted about the same. I believe that there is a cumulative effect, hence you will need repeated 3-5 treatments to get a more lasting effect. So I am getting another round today :). We charge RM 1800 per treatment and there are packages available. The procedure takes approximately 1 hour with numbing. The good thing is that its autologous, meaning that it comes from yourself, so there is less chance of allergic reactions or risk of excessive scarring. The best thing about doing this is the superficial effect on the skin. My bosom feels softer and look more refine compared to before and the skin tone is fairer. I have found very fascinating results with PRP, and am really considering to conduct a proper controlled study on this topic.

Preventing Breasts From Sagging

Recent studies have shown that wearing a bra causes more sagging to the breast. Prof Roullin from France did a 15 year comprehensive study on hundreds of women and recently published his findings. Rouillon found that women who never wore bras had nipples on average seven millimeters higher in relation to their shoulders each year than regular bra users. Apparently, the slight bounce that you get when you walk is important for the ligament's development and using tight bras from a very young age for long term impedes this process. So it looks like we have to reduce our bra wearing activities... O...o.

Cutting down and quitting smoking is another way to prevent early sagging. Nutrition has shown to play a role too. A healthy diet that consists of good proteins help to keep the breasts in shape. Vitamin C and E plays a role for skin health and helps to keep the skin around the breast firm to reduce sagging. Some people believe in phytoestrogens to perk up breast size and keep it firm. Although it may be beneficial, be careful with hormones as some preparations may increase risk for breast cancer and other problems.

Exercise is another important factor. Push ups, arm lifts, free weight lifting, resistance exercises or any form of exercise that strengthens your chest muscles (pectoralis, trapezius etc) will help to keep your breasts firm and looking good. Postural fixing, and back exercises helps with excessive weight of the chest.

For more info on the treatments mentioned here or for appointments please call Faceworks Clinic 03-21440080 or 014-2233268 or email us at faceworksclinic@gmail.com. Like us on Facebook https://www.facebook.com/FaceworksClinic to get the latest news and blogs.

Love your breasts.... October is Breast Cancer Awareness Month :)

It's October again, my favourite month. This year I have just turned 33 and I am loving every moment of my life. This is also the pink month. That's right, Breast Cancer Awareness Month. Wear the pink ribbon to support breast cancer awareness. The published statistics shows that every 1 in 19 women in Malaysia is at risk of getting breast cancer. However, we believe this number to be higher i.e. perhaps 1 in 11 as there were many late detections compared to earlier ones.

Breast Cancer may be fatal but you will be able to survive if detected early enough! So for this blog entry, I am also going to include steps for breast self examination. This simple 5 step test in the shower or on your bed could well save your life, so I hope all my readers can make this a weekly routine, especially if you are above the age of 35 or have a family history of breast cancer.

What are the risk factors for breast cancer?

Risks you cannot change:

1. Gender - Women are 100x more likely to develop breast cancer than men.

2. Age - The older you get your risk increases more.

3. Genetic risk factors - 5-10% of breast cancer cases are thought to be hereditary.

• BRCA1 and BRCA 2 are the most common cause of hereditary breast CA. Lifetime risk for families with BRCA1 is on average 55-65% with as high as 80% and more common in Caucasians. For BRCA 2 mutations, the risk is lower around 45% and more commonly found in Asians and Hispanics. Usually the disease with these mutations occur in much younger women and more often affects both breasts. Women with these mutations also have a higher risk of developing ovarian cancer.
• Changes in other genes - These gene mutations are much rarer and often do not increase the risk for breast cancer as much as the BRCA genes.
• ATM gene which helps repair damage DNA. Inheriting 2 abnormal copies of this gene causes ataxia-telangiectasia. Inheriting 1 mutated copy of the gene is linked to a high rate of breast cancer in families.
• TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause Li-Fraumeni syndrome which has an increased risk of developing breast cancer, leukemia, brain tumours and sarcomas.
• CHEK2 gene : Can also cause Li-Fraumeni syndrome and even if it does not, increases breast cancer risk 2-fold if mutated.
• PTEN gene normally helps regulate cell growth. Inherited mutation of this gene can cause Cowden syndrome, which people are at increased risk of both benign and malignant breast tumours.
• CDH1 inherited mutations causes hereditary diffuse gastric cancer and women with mutations in this gene also has an increased risk of invasive lobular cancer.
• STK11. Defects in this gene can cause Peutz-Jeghers syndrome which has an increased risk of many types of cancer including breast cancer.

4. Family history of breast cancer - Risk is higher among women with close blood realtives who have the disease.

5. Personal history of breast cancer - If you have had one before, the chance for a new breast cancer is 3-4x more.

6. Race and ethnicity. African American have a higher risk - Asians, Hispanic and Native-American have a lower risk.

7. Dense breast tissue.

8. Certain benign breast conditions.

• Non-proliferative lesions - no increase risk. Includes fibrosis, simple cysts, mild hyperplasia, adenosis, ductal ectasia, Phyllodes tumour, a single papilloma, squamous and apocrine metaplasia, epithelial-related calcifications, other benign tumours & Mastitis.
• Proliferative lesion without atypia (no overgrowth of cells). Increase risk slightly by 1.5-2X normal. Includes usual ductal hyperplasia, fibroadenoma, sclerosing adenosis, papillomatosis and radial scar.
• Proliferative lesions with atypia (with overgrowth of cells). Increase risk 3.5-5X higher than normal. These type of lesions include atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).

9. Lobular carcinoma in situ (LCIS) - the cells that look like cancer cells are growing in the lobules of the milk producing glands of the breast but they do not grow through the wall of the lobules. Women with this condition have 7-11X increased risk of developing invasive cancer in either breast.

10. Menstrual period - early menarche (before 12 years old) or late menopause is also a risk factor.

11. Previous chest irradiation for other cancer treatments - i.e. higher risk when exposure given earlier in life compared to later.

Lifestyle-related factors and breast cancer risk

1. Women with no children or late childbirth has higher risk for breast cancer.

2. Oral contraceptive pills - but reduces once stopped.

3. Depo-Provera contraception injections increases breast cancer risk.

4. Hormone therapy after menopause increases risk for breast cancer. Combined hormone therapy increases risk to getting and dying of breast cancer. Bioidentical hormones although safer in handling menopausal symptoms have not shown any evidence that they are safer and more effective in breast cancer.

5. Estrogen therapy does not increase risk for breast cancer, but increases risk for ovarian cancer and formation of blood clots and strokes.

6. Breast feeding slightly reduces risk for breast cancer especially if continued to 1.5-2 years.

7. Alcohol consumption is linked with an increased risk for developing breast cancer. The more you drink in a day, the higher the risk.

8. Being overweight or obese after menopause increases breast cancer risk. The risk appears for those who gained weight as an adult, rather than overweight since childhood. Excess fat in the waist area contributes more to the risk.

9. Higher levels of insulin in the body increases breast cancer risk.

10. Physical activity i.e. exercise reduces breast cancer risk. Walking 1.25-2.5 hours a week reduces risk by 18%.

11. There is no strong evidence that taking supplements reduces risk for breast cancer.

12. Chemical compounds in the environment is thought to increase risk for cancer but studies are still inconclusive.

13. Long term heavy smoking is linked to higher risk of breast cancer.

14. Several studies suggest that women who work at night (night shifts) may have an increased risk of developing breast cancer.

     Breast cancer is a major issue due to the many deaths and disability caused by it. In Malaysia it is the number one cancer for women and the mortality is high if not detected earlier. The best way to get early detection is via breast self examination. Its a simple 5 step home examination that allows you to detect any abnormalities in your breasts. If you detect anything weird about your breasts as per mentioned in the diagrams, do not hesitate to see a doctor. Funnily, a lot of people I meet are so scared to see a doctor and get a diagnosis. I think we should encourage people to seek proper treatment as early as possible. It is frustrating to get patients at stage 3-4 whom have noticed changes earlier but ended up going to a bomoh or sinseh because they were to scared to see a doctor. And when they deteriorate and die in the hospital, it is the doctors fault. Doctors are healers based on science and evidence, we can only do so much or know as much as what the patients is willing to tell you and based on the clinical findings and examination.

So what are the 5 steps:

Your breast self-exam should be done the same time every month, 7-10 days after

the start of your period if menstruating. If not, use a fixed day each month.

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here's what you should look for:

• Breasts that are their usual size, shape, and color
• Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor's attention:

• Dimpling, puckering, or bulging of the skin
• A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
• Redness, soreness, rash, or swelling

Step 2: Now, raise your arms and look for the same changes.

Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.

Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

5 simple steps to be done every week. Early detection saves lives. I hope all my readers would make this a habit. For my next entry, I will explain about medical aesthetic methods to maintain and beautify your breasts :).